Checklist Workers Compensation Claims

8/2/2019 Checklist Workers Compensation Claims

1/8

Copyright Envision SBS. 2007. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. IT IS ILLEGALAND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY,THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

CHECKLIST

HANDLING WORKERS COMPENSATION CLAIMS

The initial period is critical in handling workers compensation claims. So you must be sure to:

Immediately

Administer first aid

Accompany injured worker to a selected medical provider

Report incident within company

Notify family

Assign responsible person to follow claim

First day

Report to claim handler outside company (insurance company or third-party administrator)

Determine, on a preliminary basis, whether the injury is covered by workers compensation

Counsel employee and/or family on claims procedures, available benefits, companys continuinginterest in employees welfare, etc.

Follow up with the employee or family

First week

Coordinate payment of initial benefits

Talk to treating physician to learn diagnosis and treatment plan

Evaluate whether medical rehabilitation is necessary or appropriate

Develop return-to-work plan

Contact the injured employee and/or the family and forward mail

First month

Use a wellness approach (cards, phone calls, visits) to continue to reinforce companys concern Consider medical examination by independent physician, if warranted

Reevaluate treatment plan based on new medical information

Update return-to-work plan and contact the injured employee and/or the family

OngoingPARTY,THISPRODUC

TINHARDCOPYORDIGITALFORM.ALLOFFENDERSWILLAUT

OMATICALLYBESUEDINACOURTOFLAW.


2/8


Continually reevaluate treatment plan

Refer for pain management evaluation of chronic pain, if appropriate

Maintain contact with the injured employee and/or the family


3/8


CHECKLIST

FOR COLLECTING INFORMATION FOR A CLAIM

Whether its the businesses owner, or someone assigned by the business owner to keep track of the claim,heres some advice for the types of information the person overseeing the claim should be gathering:

About the employee

Name, nicknames, maiden name, previous names

Addresscurrent and previous (length of time living at both addresses)

Phone number, pager number, cellular number

Social security and drivers license numbers

Sex

Date of birth

Marital status

Dependents and immediate family contact

Non-relative contact

Date of hire (state hired, if applicable)

Job classification, if applicable (insurance class or company classification)

Vehicle (type, year, license number)

Interestshobbies

Length of time as a state resident

About the injury

Time and date of injury

Date of death (if applicable)

State of injury

Nature of injury (sprain, fracture, etc.)

Body part(s) affected; any previous injury to the affected body part(s)

Source of injury (machines, hand tools, buildings, etc.)

Type of injury (fall, struck by object or vehicle, overexertion, repetitive motion trauma)

Witnesses

Work process involved (lifting, carrying, etc.)

To whom was the injury reported

Who filled out the first report of injury report

Plant or locationPARTY,THISPRODUC

TINHARDCOPYORDIGITALFO

RM.ALLOFFENDERSWILLAUTOMATICALLYBESUEDINACOU

RTOFLAW.


4/8


Job

Time and date the injury was reported

Shift, if applicable

About the claim

Date employer first notified

Who was notified, by whom?

Date employer was notified of workers compensation claim

Date insurance company or service company notified

Date state agency notified

State case number

Average weekly wage

Benefit rate

Health care providers and costs

Other benefits lost (Did the employer stop paying vacation, health benefits, etc.?)

Other benefits received

Date disability started

Date of first payment

Projected return-to-work date

Date case closed

Date of maximum medical improvement

Impairment rating

Lost days

Total benefits paid

Vocational rehabilitation activity

Subrogation (Is some third party responsible?)

Second injury fund potential

Oral statement from injured worker

Conduct the interview in a non-adversarial setting

Demonstrate concern and empathy

Allow the worker to talk

Do not rush the worker

Reenact the accident

Check for photos and/or video of the accident

PARTY,THISPRODUCTINHARDCOPY

ORDIGITALFORM.ALLOFFENDERSWILLAUTOMATICALLYBE

SUEDINACOURTOFLAW.


5/8


Written statement from injured worker

Note the location where the statement is taken

Let the employee write the statement, if possible

Statement is taken ASAP after the injury

Describe the worker pre-injury and post injury actions

Request that the worker and any witnesses sign the statement

Make sure the employee initials any changes

Give copy of statement to employee

list the date and time of the statementOral statement from witness(es)

Note witness location at the time of injury

Record witness relationship to the injured worker

Interview witnesses individually

Do not rush the witness

Make sure the statement is unrehearsed

Written statement from witness(es)

Make sure the witness writes the statement in ink

Record the stated ASAP after the injury

Make sure the witness records his/her actions before, during and after the time of injury

Request that the witness sign the statement and initial any changes

Record the date and time of the statement

Give a copy of the statement to the witness

If litigation occurs

Defense attorney, law firm

Claimant attorney, law firm

Identify judge

Costs of litigation (spending more than paying?)

History of dispute

Settlement


6/8


WARNING SIGNALS OF WORKERS COMPENSATION FRAUD

You may not discriminate against a worker who has filed previous workers compensation claims. However,when you have several of the following suspect behaviors present or you observe an emerging pattern,dont be afraid to investigate further for possible fraud or to forward your suspicions to the appropriate

authority.

About the worker

The injured worker has an unstable work history; i.e., an employee who often changes jobs

The claimant has a history of reporting subjective injuries which may include workerscompensation or liability claims

The claimant is consistently uncooperative

The injured worker has been recently terminated, demoted, or passed over for a promotion

The injured worker is in line for early retirement

The injured worker is making excessive demands

The injured worker calls soon after the injury and presses for a quick settlement of the case

The injured worker moves out of state soon after the injury

The injured worker changes his address to a post office box or receives mail via friend or relative

About the workplace

The injured workers workplace is experiencing labor difficulties

The accident occurs just prior to job termination, layoff, after formal discipline of the employee, or

near the end of the employees probationary period

About the injury

The injured worker was not injured in the presence of witnesses

The injury is a subjective one, like stress, emotional trauma, or is hard to prove, like back pain,headache, insomnia, etc.

The accident is not promptly reported by the employee to the employer

The employers first notice of the injury is from an attorney or a medical clinic, and not from theinjured worker

Physicians who have examined the injured worker have vastly differing opinions regarding theinjured workers disability

There is no sound medical basis for the disability; all physicians reports indicate a full recovery

The injured worker is claiming disability exceeding that which is normally consistent with such aninjury

The accident occurs late Friday afternoon or shortly after the employee reported on Monday

The claimant has the accident at an odd time, such as at lunch hour


7/8


The accident occurs in an area where the injured employee would not normally be

The task that caused the accident is not the type that the employee should be involved in; i.e., anoffice worker who is lifting heavy objects on a loading dock

The details of the accident are vague or contradictoryAbout the medical relationship

The claimant frequently changes physicians or medical providers

The claimant changes physicians when a release for work has been issued

A review of medical reports provides information that is inconsistent with the appearance orbehavior of an injured person; i.e., a rehabilitation report describes the claimant as being muscular,with callused hands and grease under the fingernails

The employers first report of injury contrasts with the description of the accident set forth in themedical history

The injured worker develops a pattern of missing physicians appointments

About the claim itself or the claimants attorney

The injured workers attorney requests that all checks and correspondence be sent to the attorneysoffice

The claimants attorney is known for handling suspicious claims

The attorney lien or representation letter is dated the day of the reported accident

The same doctor/lawyer combination previously known to handle the same kind of injury is handlingthis claim

The claimant is unusually familiar with workers compensation claims procedures and laws

The claimant initially wants to settle with the insurer but later retains an attorney and files

increasingly subjective complaints The claimants attorney threatens further legal action unless a quick settlement is made

There is a high number of applications from a specific firm

The claimants attorney inquires about a settlement or buyout early in the life of the claim

The claimant writes unsolicited statements about how much better he/she is, but treatmentcontinues and the claimant doesnt return to work

About outside activities

There are tips from fellow employees, friends, or relatives suggesting that the injured worker is

either working or is active in sports

The injured workers rehabilitation report shows evidence of other activity

The injured worker is in a trade that would make it possible to otherwise work while collectingcompensation

The injured worker is exaggerating an injury in order to get time off to work on personal interests;i.e., the injured worker is remodeling or building a home concurrently with the injury

The injured worker is in a seasonal business that would make it attractive to be injured during the


8/8


off-season; i.e., occupations in fields such as roofing, landscaping, plumbing, farming, masonry,etc.

The injured worker leaves different daytime and evening telephone numbers

The injured worker is never home when called or is always sleeping and cant be disturbed(especially during work hours)

Return calls to the claimants residence have strange or unexpected background noises thatindicate it may not be a residence

The claimant has several other family members also receiving workers compensation benefits orother social insurance benefits, such as unemployment

Checklist Workers Compensation Claims

Documents

Transcript of Checklist Workers Compensation Claims